Assess Your Sleep

PAP Therapy Checklist

Very few people will tell you that their CPAP worked perfectly out of the box. It requires patience to get right. But if you take heart, and maintain persistence, the results can be amazing. To get that match, you'll be trying masks and pressures, and perhaps various PAP technologies. The following survey shows you questions that help us determine how patients are doing in their quest for the optimal result, and indicate how we might be able to improve things.

PAP Therapy Follow-up Form

The Mask

{slide=Does the mask cause you any pain?|closed}

No mask should cause pain; if the pain cannot be eliminated; it’s the wrong mask

Repositioning, loosening straps and insuring that the mask is the right size and properly applied to the face may solve the problem

Pain may be due to the wrong style; consider whether your facial features would do better with a full face mask, an over the nose mask, or a nasal pillows interface, or one of the new combo interfaces.

No mask should cause discomfort; if the discomfort cannot be eliminated; it’s the wrong mask

Repositioning, loosening straps and insuring that the mask is the right size and properly applied to the face may solve the problem

Discomfort may be due to the wrong style; consider whether your facial features would do better with a full face mask, an over the nose mask, or a nasal pillows interface, or one of the new combo interfaces.

Comfort issues can often be remedied with “jury-rigging,” for example, bandaides, gauze, paper tape, Velcro straps, etc. may be attached and manipulated in various ways on the mask to further displace pressure to relieve discomfort

{slide=Does the mask leak?}

Regular cleaning of mask, usually once a week with mild soap and warm water; Daily if facial oil residues are present

Avoid applying facial creams/lotions to area of face where mask makes contact.

Leaking is most often due to the wrong size mask, poor fitting mask, mask not snug enough, or improperly applied mask to facial surface.

Old masks are another common cause leaks as the material may crack or simply not hold its position in a stable manner against the face.

{slide=Are you satisfied with your overall fit?}

Verify proper headgear fit and proper adjustment

Verify proper mask size

Switch to another mask, perhaps different style; and/or switch between styles every couple of days

Improvise as needed to improve the fit of the mask, using “jury-rigging.” You’ll find many tips on www.cpaptalk.com.

{/slides}

The Pressure

{slide=Does pressurized air cause you any discomfort?|closed }

Pressure may be too high

Pressure may be just right, but you haven’t adjusted to pressure yet. Talk with your doctor about using a ramp function or starting out with lower pressures.

{slide=Does pressurized air cause you any difficulty breathing? }

Pressure may be too high

Pressure may be just right, but you haven’t adjusted to pressure yet. Talk with your doctor about using a ramp function or starting out with lower pressures.

{slide=Does pressurized air make it hard to breath against the pressure?}

This is a very common complaint, and suggests that the individual is having trouble breathing out when pressurized air is coming in. In general we find this occurring in more sensitive or anxious patients, yet it can occur in almost anyone on fixed CPAP pressures. For this reason, we now use a device called bilevel that drops the pressure during exhalation and

In particular the CPAP Pressure may be just right on inhalation but too high for exhalation.

Pressure may be just right, but you haven’t adjusted to pressure yet. Talk with your doctor about using a ramp function, starting out with lower pressures, or coming back for a bilevel retitration study.

{slide=Are you adjusting well to pressurized air? }

If mask and pressures issues have been attended to and the adjustment is still not going well, then it is imperative to meet with your sleep medical provider to discuss the problem

You may be have the wrong pressures or the wrong pressure delivery system and only by going back to the sleep lab for another titration test can these issues be addressed

If big factor here could be mouth breathing or related problems with breathing through your nose. If you continue to mouth breath or notice difficulty in breathing through your nose, then an evaluation by an ENT specialist or an allergist is well worth you time.

Too much humidity can also be a factor in difficulty breathing with PAP. Make sure your humidifier heat setting is set just to where you don’t have dry mouth but make sure also that there is no condensation in your mask.

{/slides}

The Side Effects

{slide=Have you developed any sores or skin irritations?|closed}

Issues regarding mask pain/discomfort may be the major irritants

Diabetics, elderly or those with otherwise sensitive skin may need to develop a routine of alternating two different types of mask to relieve pressure on the affected skin surface and allow time for healing.

Simple’ intra-nasal irritations, due to mask and/or air pressure contact point, can sometimes be alleviated with special creams like…

{slide=Have you developed any air swallowing or feeling bloated in the morning?}

There can be several causes of this symptom, the most common of which is mouth breathing, which may be remedied by wearing a chinstrap, mouth taping, or a full face mask.

It’s also very important to consult with your sleep physician, because, we have found that many people with air swallowing (aerophagia) suffer from another sleep disorder known as leg jerks [(periodic limb movement disorder (PLMD)]. It seems that the leg jerks awakens the patient who then swallows air. We’ve noted that many patients treated for leg jerks no longer report aerophagia.

{slide=Have you developed any worsening of allergies, congestion, or sinus problems? }

Proper maintenance and regular cleaning of machine, machine filters, tubing, humidifier chamber and mask are needed to keep bacteria and other irritants to a minimum.

A very large number of CPAP users must develop an aggressive program to treat allergies or congestion by using regular nasal saline rinses of the nasal passages or Netipot washes, anti-allergy sprays such as Nasalcrom, Nasal Steroids and related medications such as antihistamines, and regular use of a nasal dilator strips such as Breathe Right. Developing a zero tolerance policy towards nasal congestion is a major step forward in optimizing the response to PAP therapy.

Some people with a condition known as “non-allergic rhinitis” notice that the air blowing into their nasal passages worsens their congestion. These individuals must develop a precise program with their primary physician or allergist to solve the problem, otherwise pressurized air will continue to aggravate the congestion.

{slide=Have you developed any claustrophobia?}

Claustrophobia usually arises in two types of patients. The first is the patient with true claustrophobia for which additional treatment such as a specific phobia desensitization may be needed before the patient attempts regular use of the breathing mask.

The second and more common type is a quasi-claustrophobia response in which the patient suffers some anxiety that might trigger panicky feelings. With the proper mask and pressure desensitization steps, these feelings usually subside.

Many patients with difficulty breathing through their noses are more at risk for claustrophobic responses. We see patients with deviated septums respond much better once the nasal passages were evened out. So, a visit to your ENT Physician may be important.

{slide=Have you developed any embarrassment?}

Although this symptom is declining because so many people are now using and embracing PAP therapy, there are still a fair number of CPAP users whose major barrier is embarrassment.

Embarrassment usually develops for a few difference reasons, the most common being that it feels uncomfortable to be wearing such a weird device around a loved one, and the device would not appear to invite or encourage romantic encounters.

Regrettably, we haven’t figured out a way to convert all the tubes and straps into some kind of dual purpose sex toy, but we hope you can appreciate that if PAP therapy works well for you, it has the tendency to increase energy levels in general and libido specifically.

Embarrassment issues may be so strong in some users, it actually becomes a therapy issue requiring marital or couples counseling

Embarrassment is an emotion that if left unchecked can intensity into stronger emotions such as shame. The most important first step for anyone who suffers from embarrassment about using PAP therapy is be honest with yourself about the feelings, and then if feasible talk to the person with whom this feeling arises in the bedroom